Authors:Ilenia Coluzzi; Angelo Iossa; Elena Spinetti; Gianfranco SilecchiaAbstract: Introduction Laparoscopic sleeve gastrectomy (SG) represents, at present, the most performed bariatric procedure worldwide with excellent long-term results on weight loss and comorbidities control. After the gastrectomy procedure, together with hormonal modification, several changes in taste and habits occur, including the potential modification in alcohol consumption. The aim of this prospective study was to determine the frequency and the amount of alcohol use before and after SG using a modified version of the Alcohol Use Disorder Identification Test (AUDIT) at 1-year follow-up and eventually to evaluate relationships between different ages and sexes. Materials and methods A total of 142 patients were prospectively enrolled and evaluated before and 1 year after SG with a modified AUDIT. The exclusion criteria were as follows: history of alcohol abuse, presence of psychopathology or cognitive impairments, diabetes mellitus type II decompensated, or previous gastrointestinal, liver, and pancreatic resective surgery. Subgroup analyses were performed between male and female and between under and over 40 years old. Results The median AUDIT score decreased from 2.70 (range 1–18) before surgery to 1.38 (range 1–7) after 1 year of SG, indicating a marked reduction in alcohol use. The most consumed alcoholic drink was beer (36.6%/n = 52) while after surgery the consumption of beer decreased considerably (21.1%/n = 30). The frequency of alcohol consumption also decreased: at baseline 45% of patients consumed alcoholic drinks “from 2 to 4 times per month”, whereas 26 and 39.4% consumed alcohol “never” and “less than once a month,” respectively. After surgery, nobody consumed more then six alcoholic drinks. No differences were found between the subgroups in terms of alcohol consumption and social behavior. Conclusions The alcohol preference is modified and decreased 1 year after SG and this could be related to the strict nutritional follow-up and to the hormonal changes. Studies with large samples and long-term follow-up are needed to confirm our data. Level of evidence IV.PubDate: 2018-02-06DOI: 10.1007/s40519-018-0486-1

Authors:Friederike Barthels; Frank Meyer; Reinhard PietrowskyAbstract: Purpose Orthorexic eating behaviour, restrained eating, and veganism/vegetarianism are food selection strategies sharing several characteristics. Since there are no studies investigating their interrelationships, aim of the present study was to analyse orthorexic and restrained eating behaviour in (1) a sample of vegans and vegetarians and (2) a sample of individuals on a diet to lose weight. Method Division of samples according to pre-defined criteria in (1) vegans (n = 114), vegetarians (n = 63), individuals with rare meat consumption (n = 83) and individuals with frequent meat consumption (n = 91) and in (2) participants on a diet with dietary change (n = 104), without dietary change (n = 37) and a control group of individuals not on a diet (n = 258). Orthorexic eating behaviour was assessed with the Düsseldorfer Orthorexie Skala and restrained eating was assessed with the Restraint Eating Scale. Results Vegans and vegetarians do not differ in orthorexic eating behaviour, but both groups score higher in orthorexic eating behaviour than individuals consuming red meat. There are no differences regarding restrained eating. Individuals on a diet with dietary change score higher in both orthorexic and restrained eating, than individuals without dietary change and individuals not on a diet. Conclusions Individuals who restrict their eating behaviour, either predominantly due to ethical reasons or with the intention to lose weight, display more orthorexic eating behaviour than individuals not limiting their food consumption. Further research is needed to investigate whether veganism, vegetarianism, or frequent dieting behaviour serve as risk factors for orthorexia. Level of evidence Level V, cross-sectional descriptive study.PubDate: 2018-02-03DOI: 10.1007/s40519-018-0479-0

Authors:Rocco Barazzoni; Gianluca Gortan Cappellari; Maurizio Ragni; Enzo NisoliAbstract: Obesity is a major health risk factor, and obesity-induced morbidity and complications account for huge costs for affected individuals, families, healthcare systems, and society at large. In particular, obesity is strongly associated with the development of insulin resistance, which in turn plays a key role in the pathogenesis of obesity-associated cardiometabolic complications, including metabolic syndrome components, type 2 diabetes, and cardiovascular diseases. Insulin sensitive tissues, including adipose tissue, skeletal muscle, and liver, are profoundly affected by obesity both at biomolecular and functional levels. Altered adipose organ function may play a fundamental pathogenetic role once fat accumulation has ensued. Modulation of insulin sensitivity appears to be, at least in part, related to changes in redox balance and oxidative stress as well as inflammation, with a relevant underlying role for mitochondrial dysfunction that may exacerbate these alterations. Nutrients and substrates as well as systems involved in host–nutrient interactions, including gut microbiota, have been also identified as modulators of metabolic pathways controlling insulin action. This review aims at providing an overview of these concepts and their potential inter-relationships in the development of insulin resistance, with particular regard to changes in adipose organ and skeletal muscle.PubDate: 2018-02-03DOI: 10.1007/s40519-018-0481-6

Authors:Chaomin Zhou; Yongqiang Li; Xiaofei Shao; Hequn ZouAbstract: Purpose Assessing and comparing the ability of the hypertriglyceridemic waist (HW) phenotype and anthropometric obesity indexes to identify subjects at high risk of chronic kidney disease (CKD) in a relatively lean population in South China. Methods Using data from a community-based, cross-sectional study conducted in Zhuhai City, Southern China, we examined associations between the HW phenotype, anthropometric obesity indexes, and incident CKD risk in a relatively lean population. Multiple logistic regression analyses were used to evaluate the associations. Results The HW phenotype associated with CKD significantly in the unadjusted analysis (OR 3.53, 95% CI 1.65–7.52, P = 0.001). Further adjustment for gender, age, and other potential confounding variables had an impact on the odd ratios (OR); the OR decreased but still existed (OR 2.91, 95% 1.23–6.87, P = 0.016). The association of the HW phenotype with CKD remained significant after further adjustment for hypertension and diabetes. No significant association between the anthropometric indexes and incident CKD was found. Conclusion The HW phenotype, but not the anthropometric indexes, is associated with an elevated risk of CKD in relatively lean subjects. The HW phenotype appears to be a better predictor of CKD than the anthropometric indexes. Level of evidence Level V, descriptive study.PubDate: 2018-01-25DOI: 10.1007/s40519-017-0476-8

Authors:Maria Cristina Stefanini; Maria Rita Troiani; Michela Caselli; Paolo Dirindelli; Stefano Lucarelli; Saverio Caini; Maria Grazia MartinettiAbstract: We focused on carers of subjects suffering from eating disorders (ED), and studied the characteristics that mostly expose them to high levels of stress, anxiety, depression and expressed emotion, favoring the accommodation of the family system to the cared person. We administered the accommodation and enabling scale for eating disorders (AESED) questionnaire, the family questionnaire (FQ) and the depression, anxiety and stress scale (DASS-21) questionnaire to 97 carers of 62 ED patients, and investigated the carer’s characteristics associated with the scores in the three questionnaires. A personal history of ED, being the primary carer, and caring for a person with a diagnosis of anorexia nervosa are the characteristics that contribute most to aggravate the carers’ burden in terms of stress, anxiety, depression, accommodation and enabling. Our findings may help doctors to provide effective support to caregivers and eventually improve the treatment of subjects with ED.PubDate: 2018-01-24DOI: 10.1007/s40519-018-0480-7

Authors:Simona Calugi; Massimiliano Sartirana; Chiara Milanese; Marwan El Ghoch; Federica Riolfi; Riccardo Dalle GraveAbstract: Background The Clinical Impairment Assessment (CIA) is a measure of functional impairment secondary to eating disorder symptoms. Aim The aim of this study was to examine the psychometric proprieties of the Italian-language version of the CIA. Methods The tool was translated into Italian and administered to 259 Italian-speaking in- and outpatients with eating disorders and 102 healthy controls. The clinical group also completed the Eating Disorder Examination Questionnaire (EDE-Q) and the Brief Symptom Inventory (BSI). Results Confirmatory factor analysis revealed a good fit for the original three-factor structure. Internal consistency was high for both the global CIA and all subscale scores, and test–retest reliability was acceptable. The high correlation between CIA and EDE-Q and BSI confirmed the convergent validity of the instrument. T test indicated higher raw scores on CIA in patients with eating disorders than healthy controls, and a cut-off score of 16 on the CIA discriminated between eating disorder and general psychopathology scores. Finally, global CIA and subscale scores were significantly higher in patients who reported objective bulimic episodes, purging behaviours, and excessive exercising than in those who did not; in underweight than in not-underweight patients, and in inpatients than outpatients, confirming the good known-groups validity of the tool. Conclusions Overall, the study showed the good psychometric properties of the Italian version of the CIA, and validated its use in Italian-speaking eating disorder patients. Level of Evidence Level V, Descriptive study.PubDate: 2018-01-24DOI: 10.1007/s40519-018-0477-2

Authors:Graziella Fava Vizziello; Laura BellinAbstract: During the longitudinal study of three patients, referred to services at 3, 13, 15 years for eating disorders, reduced food intake and anorexia nervosa, other symptoms appeared depending on difficult development, relational and personality problems. The patients showed the interweaving of symptoms at different times: they were dealing with modified developmental needs and contexts, included new possibilities of attachment that might produce different internal organizations. These changes required different treatments. Anorexia started early in life for these girls, but presented different steps of organization. We wanted to start finding some aspects of a staging model to map the course of ED, because many patients arrived later in life, reported untreated early symptoms, actually personality traits. Mapping the evolution, could allow to take care of patients at the very early stage of problems when few symptoms are present, and better patients’ evolution might be possible. Level of evidence Level V opinions of respected authorities based on clinical experience.PubDate: 2018-01-08DOI: 10.1007/s40519-017-0464-z

Authors:Sylke Andreas; Kirsten Schedler; Holger Schulz; Detlev O. NutzingerAbstract: Purpose In recent years, a new term—orthorexia nervosa (ON)—has been introduced in the field of clinical assessment and psychotherapy. Orthorexia nervosa is defined as a fixation on healthy food and a pathological obsession to eat food with more natural, higher quality ingredients. Although instruments to measure ON are available, no study on the psychometric properties of the original developed instrument by Bratman (Orthorexia nervosa: Overcoming the obsession with healthful eating, Broadway Books, New York, 2000) in a large clinical sample exists until now. Methods The study was conducted in a large clinic in Germany. The study sample consisted of N = 1122 inpatients, 70% were female, and the mean age was 41 years (SD = 14 years). The main diagnoses at the end of treatment were affective disorders (46%), followed by eating disorders (13%), anxiety disorders (10%), and personality disorders (10%). The patients filled out several instruments, like the Ortho-10, the 10-item version of the orthorexia nervosa instrument, and other construct-related, disorder-specific and construct-distant instruments. Results The exploratory factor analysis revealed a two-factor structure: an eating disorder-specific factor and an orthorexia-nervosa specific factor. The eating disorder factor showed good convergent and discriminative validity in which patients with eating disorders and those without could correctly be classified. However, the orthorexia-nervosa specific factor revealed no informational gain compared to the eating disorder-specific factor in this clinical sample. Conclusions Further investigation is necessary to approach the concept of ON and its sense in clinical samples. Level of evidence Level II: evidence obtained from well-designed controlled trials without randomization.PubDate: 2018-01-02DOI: 10.1007/s40519-017-0473-y

Authors:Ashleigh A. Pona; Angela C. Jones; Tracy L. Masterson; Denise D. Ben-PorathAbstract: Purpose To investigate attentional and memorial biases towards body shape pictures among female patients with clinical eating disorders and healthy female controls. Methods A visual dot-probe task was used to assess attention towards pictures reflecting either a thin, normal, or obese female body shape. Pictures were presented in pairs; each pair depicted two different body shapes and were presented twice. Participant responses were compared across time and population. Results Overall, the eating disorder patients responded more slowly than controls, F(1,63) = 20.32, p < .001. Both groups showed an attentional bias towards the larger of two body shapes, F(1,63) = 4.30, p = .04, and responded more quickly the second time they viewed the picture pairs, F(1,63) = 33.80, p < .001. Upon second viewing of picture pairs, the eating disorder patients had a larger decrease in reaction time (86 ms) than the control sample (33 ms) only when both pictures included extreme body shapes (thin and obese); the decrease in reaction time when one of the pictures included a normal body shape was the same across groups upon second viewing (eating disorder: 37 ms; control: 32 ms), F(1,63) = 9.32, p = .003. Conclusions These findings suggest that individuals with eating disorders may be biased towards recall of dichotomous and/or extreme body shape images. While it remains unclear whether attentional and/or memorial bias is a risk, maintenance, or causal factor in eating disorders, future studies should employ longitudinal, prospective research designs to address these questions. Level of Evidence Level II, comparative study.PubDate: 2017-12-28DOI: 10.1007/s40519-017-0472-z

Authors:Ana Carolina Aguiar-Bloemer; Rosa Wanda Diez-GarciaAbstract: Purpose Considering the importance of replicating real-life experiences in studying emotional eating, this study investigated the influence of emotions evoked by life events on food choice in normal-weight and overweight women. Methods Normal-weight (n = 21) and overweight women (n = 23) aged 25–42 years were assigned to one of two different conditions: in one, they were shown a video with scenes of daily activities to elicit neutral responses; in the other, they were shown a video with scenes of common problems to evoke negative emotions. The participants were then offered a brunch containing sweet, salty, and healthy food items to evaluate their consumption and food choice. Results Exposure to negative emotions evoked by life problems increased energy intake in both groups, but they differed in terms of food choice. The normal-weight women increased only the consumption of sweet food (p = 0.044), whereas the overweight women significantly increased ingestion of sweet and salty foods (sweet food p = 0.031; salty food p = 0.008). Conclusions The results show that common problems of life might trigger food consumption in the presence of high availability. Both groups increased food consumption after negative emotions and the normal-weight group had a higher increase than the overweight group. However, normal-weight women increased consumption of sweet foods, whereas overweight women consumed more salty, fried, and sweet foods. Healthy food was not chosen under these conditions. This should serve as a warning for the risks of excess exposure to high-sugar or high-fat food as everyday problems will not cease to exist. Level of evidence Level II: evidence obtained from well-designed controlled trials without randomization.PubDate: 2017-12-28DOI: 10.1007/s40519-017-0468-8

Authors:Crystal D. Oberle; Ryan S. Watkins; Andrew J. BurkotAbstract: Purpose This research explored the exercise tendencies and motivations of individuals varying in orthorexia symptomatology. Method Participants were 411 university students, who completed the Eating Habits Questionnaire alongside measures of exercise activity and addiction in Study 1 (a modified version of the Leisure-Time Exercise Questionnaire, the Exercise Addiction Inventory, and the Compulsive Exercise Test) and various exercise motivations in Study 2 (the Behavioural Regulations in Exercise Questionnaire and the Exercise Motivations Inventory-2). Results Orthorexia symptomatology was positively correlated with aerobic and strength-training exercise levels; all measures of exercise addiction; all measures of internal exercise motivation; and nearly all measures of exercise motivation for the purposes of psychological, social, health, and body improvement. Symptomatology was not significantly related to either measure that specifically assessed external motivation to exercise. Conclusion Individuals high in orthorexia symptomatology are internally driven to exercise for the purposes of improving their physical and mental health, but these strong motivations also lead to exercise addiction characterized by a compulsive need to follow a rigid schedule of intensive exercise even in the face of injury, illness, or other problems. Level of evidence Level V, descriptive cross-sectional study.PubDate: 2017-12-20DOI: 10.1007/s40519-017-0470-1

Authors:Lívia Moreira Barros; Natasha Marques Frota; Thiago Moura de Araújo; Michelle Tellez; Heloisa Helena Peres Ciqueto; Joselany Áfio CaetanoAbstract: Background The Internet, particularly blogs have become an important tool for patients to disseminate and exchange information on a variety of health topics, including bariatric surgery. By virtue of its interactivity being free of judgement from health care providers, blogs expose gaps in patients’ knowledge and understanding. Purpose This study analyzes the main doubts expressed in blogs by patients in the postoperative period of bariatric surgery. Method This is a qualitative exploratory study of 11 blogs of patients, who underwent bariatric surgery, that were available on the Internet between October 2013 and May 2017. The data were collected through a structured instrument and analyzed according to Bardin’s suggestions. The sampling method used was intentional. Results Evolution of diet, weight loss, plateau effect, weight regain, physical exercises, physiological changes, complications, use of contraceptive and pregnancy were the main areas of concern. Conclusion More needs to be done to educate and prepare bariatric patients for the postoperative period. The content found in blogs serves towards building better links with patients, helps them make better decisions, and provides them an opportunity to be active participants in their own treatment.PubDate: 2017-12-18DOI: 10.1007/s40519-017-0465-y

Authors:Valeria Guglielmi; Paolo SbracciaAbstract: Obesity, defined as excess fat mass, increases risks for multiple chronic diseases, such as type 2 diabetes, cardiovascular disease, and several types of cancer. Beyond adiposity per se, the pattern of fat distribution, android or truncal as compared to gynoid or peripheral, has a profound influence on systemic metabolism and hence risk for obesity complications. Not only factors as genetics, environment, gender, and age account for the apparent compartmentalization of white adipose tissue (WAT) in the body. Indeed, the heterogeneity among different anatomical depots also appears to stem from their intrinsic diversity, including cellular developmental origin, proliferative capacity, glucose and lipid metabolism, insulin sensitivity, cytokine pattern, thermogenic ability, and vascularization. Under the obese condition, these depot-specific differences translate into specific WAT distribution patterns, giving rise to different cardiometabolic consequences. This review summarizes the clinical and mechanistic evidence for the depot-specific differences and the phenotypic characteristics of different WAT depots that link their depot-specific biology to obesity-specific complications.PubDate: 2017-12-11DOI: 10.1007/s40519-017-0467-9